Provider Demographics
NPI:1336267566
Name:WINE, MARY CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINE
Last Name:WINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18070 SAGECROFT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6724
Mailing Address - Country:US
Mailing Address - Phone:281-550-9115
Mailing Address - Fax:
Practice Address - Street 1:650 MEYERLAND PLAZA MALL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1617
Practice Address - Country:US
Practice Address - Phone:281-974-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice